Forty-five years ago, U.S. Rep. John J. Gilligan cast one of the 307 House votes that created Medicare and Medicaid.

That piece of "Great Society" legislation changed the delivery of health care in America.

Now Gilligan's daughter, Kathleen Sebelius, the health and human services secretary, is the general in charge of another sweeping change in the health care system.

Implementing the health-care overhaul bill passed earlier this year makes her one of the most powerful bureaucrats in the country, with one of the toughest jobs.

How important is her role?

Forbes magazine last year ranked her the 57th-most powerful woman in the world.

Gilligan, now retired after a public service career in Ohio, admits he's "a little prejudiced" but says that "he can't imagine anyone doing a better job. She's steady. She's not a volatile person. And everything she's ever done has contributed to her ability to handle the stress and strain."

Less-partial observers agree that Sebelius is handling the job with aplomb, even as it puts her on the hot seat for critics of "Obamacare."

"You have to deal with what comes at you," Sebelius shrugged with characteristic understatement in a recent radio interview. "You use the resources you have and figure it out. … You don't get time to say, 'Let's stop for a month or two.' "

Here's what the former legislator, insurance commissioner and Kansas governor is facing:

The massive health care law says "the secretary shall" make roughly 1,300 decisions on provisions in the law, everything from the smallest detail to defining what constitutes "essential" health care.

She's charged with leading teams of government regulators who will add an expected 30,000 to 50,000 pages of regulations to the 2,800-page law.

And "she's writing those regulations under such a cloud of uncertainty. Everything she does will become a political football," said Patrick Tuohey, who managed the Yes on Prop C campaign in Missouri.

Tuohey is one of the health care law's most successful opponents. On Tuesday, primary voters in the state resoundingly rejected a key element of the law, the requirement that individuals purchase health insurance by 2014.

But whatever he thinks of the policies, he's charitable toward Sebelius: "I don't envy her."

Indeed, few would.

"Implementation is incredibly difficult, and unlike with Social Security or Medicare, the secretary does not have much help from the other side of the aisle," said U.S. Rep. Emanuel Cleaver, a Kansas City Democrat.

"A person not hardened and shaped by Midwestern roots would, frankly, not have been up to the task," Cleaver said. "She is a successful Democrat from Kansas, and that's no small feat."

Read more of this story at KansasCity.com